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i <br /> Afforda-Te$t - Work Order I Date U <br /> 416 2nd Street Galt,Ca 95632 Tech <br /> 209 744-0112 <br /> Site: i j�1 ` ya t c/cm 7 _ Monitor Vpr Recovery ❑ Tank Ines ` <br /> r 9, V <br /> Alarm Response/l.,br/Other <br /> ❑ Testing/Rprs Passed No Parts Needed Parts Replaced: Parts Needed: <br /> E] Repairs Needed: <br /> Lid Bolts. OK ❑ #Missing or Stripped <br /> Site Representative(print) ..i,.,t 5 <br /> Results.sent upon receipt•of payment..Most regulatory agencies require <br /> results within 30 days of testing. Please plan your payment accordingly. Site Representative Signatur . <br /> *Any issues within a few days of testing could be related to this testing,so site must call us BEFORE maintenance repairs are done by others. <br /> RECEIVED <br /> MAR 3 0 2017 <br /> i ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> E' <br />